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Health and Illness Concepts I Nursing: N1210 > Gastrointestinal System (Exam Two) > Flashcards

Gastrointestinal System (Exam Two) Flashcards

1
Q

What is constipation? Is it a symptom or a disease?

A
  • Occurs when fecal matter is held in the rectal cavity longer than usual
  • Rectal cavity may become insensitive to feces
  • Constipation is a symptom
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2
Q

Constipation that is severe and continues for a long period of time is referred to as what?

A

Obstipation

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3
Q

Stool becomes much more difficult to pass after being in the rectal cavity for how many days?

A

Three days

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4
Q

What medications may cause constipation?

A
  • Narcotics
  • Tranquilizers
  • Antacids with aluminum
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5
Q

What is the most common cause of constipation?

A

-Low intake of fiber and fluids

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6
Q

What is done to prevent constipation?

A
  • Exercise
  • Fluid consumption
  • High fiber diet
  • Avoid chronic laxative use
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7
Q

What are the signs and symptoms of constipation?

A
  • Abdominal pain
  • Indigestion
  • Rectal pressure
  • Feeling of incomplete emptying
  • Intestinal rumbling
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8
Q

What is fecal impaction? What medication may cause fecal impaction to worsen?

A
  • Dry stools that cannot be passed
  • Liquid waste may pass around the impaction causing liquid stool incontinence
  • Anti-diarrheal medications
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9
Q

What can happen if a patient with constipation uses laxatives long term?

A
  • Atrophy of colon muscles
  • Muscle thickening
  • Fibrosis
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10
Q

What is a fecaloma? What can it cause?

A
  • Mass of very hard feces
  • Causes bowel obstruction or perforation of the bowel
  • Usually requires surgical intervention
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11
Q

What can be used to treat constipation instead of laxatives?

A
  • Psyllium medications (i.e. Metamucil)

- Stool softeners

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12
Q

When should the nurse use enemas or laxatives for constipation treatment?

A

As last resort for severe constipation

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13
Q

What is diarrhea? How is it classified

A
  • Frequent loose or liquid stools

- Classified by more than three loose stools in 24 hours

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14
Q

How long does acute diarrhea last?

A

1-2 weeks

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15
Q

A patient who has diarrhea will present with what type of bowel sounds?

A

Hyperactive

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16
Q

What is the most common cause of diarrhea?

A
  • Bacterial infection (i.e. E. coli, C diff, Salmonella)

- Can also be caused by viruses (i.e. Rotavirus)

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17
Q

What are the signs and symptoms of diarrhea?

A
  • Frequent liquid stools
  • Foul smell
  • Blood or mucus
  • Rapid onset
  • N/V
  • Abdominal cramping
  • Weakness
  • Dehydration
  • Anorexia
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18
Q

What diagnostic test should be completed to test for bacteria in the stool?

A

Stool culture

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19
Q

What are the treatment options for diarrhea?

A
  • Fluid replacement (oral or IV)
  • Elimination diet
  • Antibiotics
  • Probiotics
  • Medication (i.e. Lamotil)
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20
Q

What is the appendix? What is appendicitis?

A
  • Small finger-shaped appendage attached to cecum of large intestine
  • Serves no purpose
  • Inflammation of infection of appendix
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21
Q

What are signs and symptoms of appendicitis?

A
  • Fever
  • Increase in WBC’s
  • Pain in upper abdomen
  • Pain in lower right quadrant (McBurney’s point)
  • N/V
  • Rebound tenderness
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22
Q

Where would the nurse palpate to diagnose appendicitis?

A
  • McBurney’s point

- Lower right quadrant

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23
Q

What type of bowel sounds occur with appendicitis?

A

Normal bowel sounds

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24
Q

It is common for the patient to do what for comfort during appendicitis pain?

A

Keep right leg flexed

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25
Q

What nursing management should be done for a patient with appendicitis?

A
  • NPO
  • Semi-fowlers position
  • Apply ice
  • IV antibiotics
  • NG tube
  • Monitor dressing/incision site
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26
Q

How is appendicitis treated?

A

Appendectomy

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27
Q

What can happen if heat is applied to appendix during appendicitis?

A

Appendix may rupture

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28
Q

What is peritonitis? What causes peritonitis?

A
  • Inflammation of the peritoneal cavity

- Anything that causes organ contents to be spilled into abdominal cavity

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29
Q

What are the signs and symptoms of peritonitis?

A
  • Abdominal pain that worsens with movement
  • Rebound tenderness
  • Abdominal rigidity (hardness)
  • N/V
  • Bloating
  • Hypovolemia
  • Fever
  • Sepsis
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30
Q

What type of bowel sounds are expected with peritonitis?

A

Hypoactive

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31
Q

What diagnostic tests are used to diagnose peritonitis?

A
  • CT
  • CBC
  • Laboratory analysis
  • Exploratory surgery
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32
Q

What is the normal range for WBC’s? During peritonitis, WBC’s are usually elevated above what?

A
  • 5,000 to 10,000

- Above 15,000

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33
Q

List therapeutic measures for a patient with peritonitis?

A
  • NPO
  • IV fluids/electrolytes
  • NG tube
  • Antibiotics
  • Surgery may be required
  • Wound drain
  • Pain management
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34
Q

What are the complications of peritonitis?

A
  • Intestinal obstruction
  • Hypovolemia
  • Septicemia
  • Death if left untreated
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35
Q

What is a diverticulum/diverticula? What causes diverticulum to develop?

A
  • Outpouching of bowel or mucous membrane
  • Due to increased pressure in colon
  • Due to weakness in bowel wall
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36
Q

What is diverticulosis? What can occur if food/particles get stuck in the diverticula?

A
  • Presence of multiple diverticula with no inflammation

- Can cause diverticulitis

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37
Q

What is diverticulitis?

A

Inflammation/infection of one or more diverticula

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38
Q

What are the signs and symptoms of diverticulosis?

A

No signs or symptoms present

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39
Q

What are the signs and symptoms of diverticulitis?

A
  • Constipation or diarrhea
  • Cramping in lower left quadrant
  • Fever
  • Fatigue
  • Weakness
  • Abdominal tenderness
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40
Q

Where does diverticulosis occur most commonly?

A

Sigmoid colon

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41
Q

What can cause diverticulosis?

A
  • Chronic constipation

- Insufficient dietary fiber intake

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42
Q

Who is most at risk for developing diverticulitis?

A

Older adults >60 years old

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43
Q

How is diverticulosis managed?

A

By preventing constipation

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44
Q

To allow the bowel to rest, patients with diverticulosis may require what?

A
  • Surgical resection

- Temporary ostomy bag

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45
Q

Patients with acute diverticulosis may require what?

A

Hospitalization for pain management and antibiotic therapy

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46
Q

What are dietary considerations for patients with diverticulosis?

A
  • Foods high in fiber
  • High fluid intake
  • Unprocessed bran
  • Low residue diet (low in nuts and seeds)
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47
Q

List examples of high fiber foods?

A
  • Raisins
  • Peas
  • Prunes
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48
Q

What is Crohn’s disease? What part of the digestive tract is affected by Crohn’s disease?

A
  • Chronic autoimmune inflammation of the bowel
  • Lesions are mixed with healthy tissue
  • Can affect any part of GI tract
  • Occurs in remissions and exacerbations
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49
Q

What is the cause of Crohn’s disease?

A
  • Unknown
  • Autoimmune
  • Possibly genetic
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50
Q

Who is most at risk for Crohn’s disease?

A
  • Females

- Smokers

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51
Q

What are the signs and symptoms of Crohn’s disease?

A
  • Cramping pain not relieved with bowel movement
  • Weight loss
  • Diarrhea
  • Fluid/electrolyte imbalances
  • Abdominal distention
  • Fistulas
  • Fissures
  • Possible perforated intestine
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52
Q

What is commonly used to diagnose Crohn’s disease? How is the diagnosis confirmed?

A
  • Colonoscopy with biopsy
  • Sigmoidoscopy with biopsy
  • Confirmed by granulomas in the biopsy specimen
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53
Q

What foods can cause exacerbations of Crohn’s disease?

A
  • Dairy
  • Fatty foods
  • Fresh fruit and vegetables
  • Spicy foods
  • Caffeine
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54
Q

What is the goal of treatment for Crohn’s disease?

A
  • Reduce inflammation
  • Focus on remission
  • Manage diet and fluid intake
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55
Q

What medications are used to treat Crohn’s disease?

A
  • Aminosalicylates
  • Biologics
  • Corticosteroids
  • Antidiarrheal medications
  • Immunomodulators
  • Antibiotics
  • Vitamin supplements
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56
Q

What is ulcerative colitis?

A
  • Chronic autoimmune inflammation of the bowel
  • Lesions spread in continuous pattern
  • Only occurs in the large colon and the rectum
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57
Q

What can cause ulcerative colitis exacerbations?

A
  • Tobacco
  • Radiation
  • Food preservatives
  • Diet
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58
Q

At what age(s) are Crohn’s disease and ulcerative colitis generally diagnosed?

A

Between ages 15 and 30

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59
Q

What are the signs and symptoms of ulcerative colitis?

A
  • Abdominal pain
  • Rectal pain/bleeding
  • Diarrhea
  • Malabsorption
  • Severe dehydration
  • Urgency
  • Anorexia
  • Anemia
  • Electrolyte imbalances
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60
Q

What lab might be elevated in a patient with ulcerative colitis?

A

C-reactive protein

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61
Q

What are the therapeutic measures for patients with ulcerative colitis?

A
  • Diet
  • Fluids
  • Medications
  • Surgery
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62
Q

What is the priority nursing concern for a patient experiencing an ulcerative colitis exacerbation?

A
  • Replace fluids

- Replace electrolytes

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63
Q

Can ulcerative colitis be cured?

A
  • Yes

- Entire colon must be removed

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64
Q

What is irritable bowel syndrome?

A
  • Functional problem
  • Disorder of intestinal mobility
  • Colon randomly contracts causing constipation, diarrhea, or both
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65
Q

What are the signs and symptoms of irritable bowel syndrome?

A
  • Gas
  • Bloating
  • Constipation
  • Feeling of incomplete emptying
  • Abdominal pain
  • Mucus in stool
  • Depression
  • Anxiety
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66
Q

Irritable bowel syndrome is most common in?

A
  • Females

- Flare ups occur during menstrual cycle

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67
Q

A patient with irritable bowel syndrome may be placed on what kind of diet?

A

Low FODMAP diet

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68
Q

What are causes and risk factors for abdominal hernias?

A
  • Coughing
  • Heavy lifting
  • Straining
  • Obesity
  • Pregnancy
  • Poor wound healing
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69
Q

How are hernias classified?

A

By location

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70
Q

What is a reducible hernia?

A

Herniation that is easy to return to the abdominal cavity

71
Q

What is an irreducible/incarcerated hernia?

A

Herniation that cannot be returned to the abdominal cavity

72
Q

What should the nurse expect if an incarcerated hernia becomes strangulated?

A

Emergency surgery

73
Q

What are the signs and symptoms of an incarcerated hernia?

A
  • Pain at the site
  • Vomiting
  • Nausea
  • Abdominal pain
74
Q

What is a strangulated hernia?

A

Hernia that has decreased or no blood flow

75
Q

What should the patient avoid after having a herniorrhaphy or hernioplasty?

A

Avoid heavy lifting for several weeks

76
Q

What type of foods should be avoided in patients with celiac disease?

A
  • Gluten

- Wheat, barley, rye, grains

77
Q

What type of foods should be avoided in patients with lactose intolerance?

78
Q

What is a mechanical small bowel obstruction?

A

Blockage occurs within the intestine

79
Q

What is a non-mechanical small bowel obstruction?

A

Peristalsis is impaired because of neruomuscular condition

80
Q

What is fecal vomiting?

A

Fecal matter is propelled upward

81
Q

What type of bowel sounds are associated with a small bowel obstruction?

A
  • High pitched tinkling

- Absent

82
Q

What are the therapeutic interventions for a patient with a small bowel obstruction?

A
  • NPO
  • NG tube
  • Fluid/electrolyte replacement
  • Medications
  • Surgery
83
Q

What are the different types of abdominal ostomies?

A
  • Ileostomy
  • Colostomy
  • Urostomy
84
Q

What type of patients are at greatest risk for dehydration?

A

Patients with ileoanal anastomosis

85
Q

What is an ileoanal anastomosis?

A
  • Connects illeum to anus
  • No stoma needed
  • Effluent is more liquified and mushy
86
Q

Why might a patient with an ileoanal anastomosis have a temporary ileostomy or J-pouch?

A
  • Allows everything to rest and heal

- Can be reversed

87
Q

Do patients with a J-pouch have a stoma?

88
Q

Are patients with a J-pouch able to have regular bowel movements?

89
Q

What happens with the effluent as the stoma is moved down the colon?

A
  • Less liquid

- More firm and formed

90
Q

What education should be provided to a patient with a stoma in regards to diet?

A
  • No chunks that can block stoma opening
  • Avoid fluids that cause gas (i.e. cabbage, broccoli)
  • Yogurt is helpful in reducing the smell
91
Q

What does a normal stoma look like? What education should be provided to the patient?

A
  • Pink to red in color
  • Moist
  • Watch for skin irritation due to drainage and seeping after surgery
  • May have swelling for 2-3 weeks after surgery
92
Q

What does a blueish, dusky stoma indicate? The nurse should anticipate doing what if this happens?

A
  • Inadequate blood supply

- Call HCP

93
Q

What does a black stoma indicate?

94
Q

What is hepatitis?

A

Inflammation of the liver resulting in loss of liver function

95
Q

What are the causes of hepatitis? Which of these is the most common?

A
  • Bacteria
  • Viruses (most common)
  • Drugs
  • Alcohol
  • Chemicals
96
Q

Many patients born between _____ to _____ have been infected for as many as _____ years and did not know.

A
  • 1945 to 1965

- 20 years

97
Q

What are the most common forms of hepatitis in the United States?

A
  • Hep A

- Hep B

98
Q

How is Hepatitis A transmitted?

A

Fecal-oral route

99
Q

How is Hepatitis B transmitted?

A

-Blood or body fluids (i.e. saliva, menstrual or vaginal fluid, contaminated equipment)

100
Q

How is Hepatitis C transmitted?

A
  • Blood transfusions
  • IV drug use
  • Unprotected sex
101
Q

How is Hepatitis D transmitted?

A
  • Blood or body fluids

- Must be co-infected with Hepatitis B

102
Q

How is Hepatitis E transmitted?

A
  • Contaminated water

- Raw or undercooked pork/venison

103
Q

How do you prevent hepatitis?

A
  • Good hand hygiene
  • Avoid sharing personal hygiene items
  • Avoid sharing needles
  • Use condoms
  • Vaccinations
104
Q

When can an immunoglobulin be given for hepatitis?

A

After exposure

105
Q

Describe Stage 1 of hepatitis?

A
  • Known as prodromal/preicteric stage
  • Occurs two weeks after exposure
  • Lasts about one week
  • Flu-like symptoms
106
Q

Describe Stage 2 of hepatitis?

A
  • Known as icteric stage
  • Occurs 5 to 10 days after prodromal stage
  • Lasts two to six weeks
  • Flu-like symptoms
  • Dark urine
  • Enlarged and tender liver
  • Jaundice
107
Q

Describe Stage 3 of hepatitis?

A
  • Known as convalescent stage
  • Lasts two to six weeks
  • Patient is considered recovered when liver function is back to normal
  • Patient should avoid liver toxic substances for at least one year (i.e. alcohol)
108
Q

What are the complications of hepatitis?

A
  • Acute or chronic liver failure
  • Chronic infection
  • Increased risk of liver cancer
109
Q

What labs will be elevated or decreased with hepatitis?

A
  • Elevated liver enzymes
  • Elevated bilirubin
  • Prolonged PT
  • Elevated ammonia
  • Decreased albumin
110
Q

Antivirals can be given for which forms of hepatitis?

A
  • Hep B

- Hep C

111
Q

What should patients avoid if they are hepatotoxic?

A
  • Alcohol

- Drugs (i.e. Tylenol)

112
Q

What is acute liver failure?

A
  • Rare but serious failure of liver system

- Can develop rapidly

113
Q

What is the most common cause of acute liver failure?

A

Acetaminophen overdose

114
Q

What can be given for acetaminophen overdose within one hour of the overdose?

A

Activated charcoal

115
Q

What is the antidote for acetaminophen?

A
  • N-acetylcysteine

- Can prevent hepatotoxicity if given within 8 hours of overdose

116
Q

How many milligrams of Tylenol is recommended for a daily dose?

A

3000mg/24 hours

117
Q

What should the nurse educate the patient on if they have acute liver failure?

A

OTC medications that contain Tylenol

118
Q

What are the signs and symptoms of acute liver failure?

A
  • GI symtoms (initial symptom)
  • Fatigue (initial symptom)
  • Elevated liver enzymes
  • Bleeding
  • Hypoalbuminemia
  • Abdominal distention
  • Hypokalemia
  • Blood glucose levels drop
  • Reduced liver size
  • Hepatic encephalopathy
  • Jaundice
119
Q

If left untreated, how high is the mortality rate for acute liver failure?

120
Q

What is the priority nursing concern with acute liver failure?

A

Support the airway

121
Q

What medications can be given to decrease ammonia levels?

A
  • Lactulose

- Rifaxinim

122
Q

What is cirrhosis?

A

Progressive, irreversible replacement of healthy liver tissue with scar tissue

123
Q

Cirrhosis is more common in which gender?

124
Q

What is the most common cause of cirrhosis?

A

Alcohol abuse or misuse

125
Q

Describe the characteristics of the liver during early stages of cirrhosis and late stages of cirrhosis?

A
  • Early: enlarged liver

- Late: shrink and develop grey scar tissue on the outside

126
Q

What is ascites?

A
  • Large amount of fluid build up in the abdominal cavity

- Can cause respiratory distress

127
Q

What are the causes of ascites?

A
  • Low albumin

- Portal hypertension

128
Q

What are the treatment options for ascites?

A
  • Fluid and sodium restriction
  • Diuretics
  • Albumin infusions
  • Paracentesis
  • Shunt
129
Q

What nursing management will be provided to a patient with ascites?

A
  • Monitor I&Os
  • Monitor abdominal girth
  • Monitor weight
130
Q

What is portal hypertension?

A
  • Elevated blood pressure in the portal vein

- Blood backs up into surrounding vessels

131
Q

What causes portal hypertension?

A

Obstructed blood flow from liver scarring

132
Q

Portal hypertension can cause what?

A
  • Caput medusae
  • Rectal hemorrhoids
  • Splenomegaly
  • Esophageal varices
133
Q

What is hepatic encephalopathy? What does it represent?

A
  • Decline in brain function due to increased ammonia levels

- Represents end stage liver failure

134
Q

What are the stages of hepatic encephalopathy?

A
  • Early
  • Stupor/confusion
  • Comatose
135
Q

What is used to treat hepatic encephalopathy?

A
  • Lactulose

- Antibiotics

136
Q

What are the symptoms of hepatic encephalopathy?

A
  • Progressive confusion
  • Asterixis
  • Fector hepaticus
137
Q

What is Wernicke-Korsakoff syndrome?

A
  • Complication of alcohol induced liver disease

- Deficiency in thiamine

138
Q

Wernicke-Korsakoff syndrome can progress to what?

A

Korasakoff’s psychosis

139
Q

Can Korasakoff’s psychosis be reversed?

A
  • No

- It can only be prevented

140
Q

How is Wernicke-Korsakoff syndrome treated?

A

Oral or SQ thiamin

141
Q

What nursing management should be provided for patients with cirrhosis?

A
  • Daily weight
  • Abdominal girth measurement
  • Vital signs
  • Respiratory status
  • I&Os
  • Lab values
  • Low sodium diet
  • Fluid restriction
  • Oral care
  • Monitor for bruising or bleeding
142
Q

What digestive enzymes are secreted by the pancreas?

A
  • Lipase
  • Amylase
  • Trypsin
143
Q

What is acute pancreatitis?

A
  • Inflammation of the pancreas
  • Digestive enzymes active inside of the pancreas
  • Pancreas begins to digest itself
144
Q

What is secreted by the pancreatic duct to neutralize the acidity of stomach contents in the duodenum?

A

Sodium bicarbonate

145
Q

What causes acute pancreatitis?

A
  • Autodigestion of the pancreas
  • Alcohol misuse
  • Gallbladder disease
146
Q

How is acute pancreatitis described?

A

Chemical burn to the organ

147
Q

What are the signs and symptoms of acute pancreatitis?

A
  • Severe pain (Epigastric or LUQ radiating to chest, back, flanks)
  • Rigid abdomen
  • Hypotension or shock
  • Respiratory distress
  • Low-grade fever
  • Dry mucus membranes
  • N/V
  • Jaundice
148
Q

What are the two signs of bleeding associated with acute pancreatitis?

A
  • Turner’s sign

- Cullen’s sign

149
Q

What is Turner’s sign?

A

Bleeding that causes bruising around flanks

150
Q

What is Cullen’s sign?

HINT: “C” = “C”ircle around bellybutton

A

Bleeding that causes bruising around bellybutton

151
Q

How is acute pancreatitis diagnose?

A
  • Abdominal pain
  • Increased serum amylase
  • Increases serum lipase
152
Q

Acute pancreatitis is diagnosed when either serum amylase or serum lipase is how many times the normal amount?

A

Three times the normal amount

153
Q

What are the treatment options for acute pancreatitis?

A
  • IV fluids
  • Pain management
  • H2 antagonist
  • NPO for period of time
  • NG tube
  • Antibiotics
  • Electrolytes
  • Insulin as needed
154
Q

Why would a patient with acute pancreatitis have an NG tube with suction?

A
  • To prevent the digestive enzymes from going to the small intestine
  • Allows the pancreas to rest
155
Q

Repetitive episode of acute pancreatitis can lead to what?

A

Chronic pancreatitis

156
Q

How do gallstones cause acute pancreatitis?

A

Gallstones block the pancreatic duct and block the digestive enzymes from being released

157
Q

Pancreatic cancer is the _____ leading cause of cancer related deaths in the United States.

158
Q

Who has the highest rate of contracting pancreatic cancer?

A

African American males

159
Q

What are the risk factors of pancreatic cancer?

A
  • Smoking
  • Obesity
  • Diabetes
  • Exposure to chemicals
  • Cirrhosis
  • Chronic pancreatitis
  • H. pylori infection
160
Q

What are the signs and symptoms of pancreatic cancer?

A
  • Often no signs or symptoms

- May have overall weakness or not feel well

161
Q

What is cholecystitis?

A
  • Inflammation of the gallbladder

- Can be acute or chronic

162
Q

What causes acute cholecystitis? What can it lead to?

A
  • Obstruction of the common bile duct leading to further inflammation and infection
  • Can lead to rupture of gallbladder
163
Q

Chronic cholecystitis causes the gallbladder to do what?

A

Become thick and hard

164
Q

Cholelithiasis is what?

A

Gallstones

165
Q

Cholelithiasis occur most frequently in what gender?

166
Q

What factors highly contribute to the development of cholelithiasis?

A
  • Inactive lifestyle

- High fat, high cholesterol diet

167
Q

Most cholelithiasis are composed of what?

A

Cholesterol

168
Q

Symptoms of cholelithiasis usually last how long?

A
  • 1 to 3 hours

- Follows intake of high fat meal

169
Q

Obstruction of the common bile duct can cause what?

A

-Clay colored fatty stools

170
Q

What is Murphy’s sign?

A
  • Specific to cholecystitis
  • Patient takes in and holds a deep breath while palpating the right subcostal area
  • Pain will cause an abrupt halt in inspiration
171
Q

Treatment of acute cholecystitis focuses on what?

A

Pain management

172
Q

High levels of bilirubin can cause what? What can the patient be given for this?

A
  • Severe itching

- Colestid or Questran

173
Q

What type of education should the nurse provide to a patient with cholecystectomy?

A
  • Diet!
  • Low fat, low cholesterol
  • Avoid greasy, high fatty food

Health and Illness Concepts I Nursing: N1210 (12 decks)

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